5 high cholesterol myths and facts

You may think that if you exercise regularly and choose low-fat foods, you don’t need to worry much about cholesterol. However, unfortunately, some people may live a heart-healthy lifestyle and still have a high cholesterol profile.

“High cholesterol increases one’s risk of a heart attack or stroke in the future,” says Arash Bereliani, M.D., a board-certified cardiologist in Los Angeles. High levels of cholesterol may also increase your risk of heart disease. “But the problem is heart disease often doesn’t give any warning signs until something is really wrong,” Dr. Bereliani adds. That’s why understanding your own cholesterol profile and working with a doctor can be so important, even if you don’t have any health conditions (such as type 2 diabetes or obesity) that are known to raise the risk of high cholesterol.¹

Here are some common myths about cholesterol — and facts that are important to know.

Myth: All cholesterol is bad

Fact: There are 2 types of cholesterol, and only 1 is harmful. But first, some basics: blood cholesterol is a naturally occurring substance made by your liver. It’s responsible for multiple functions in the body, including building hormones. This waxy, fat-like substance is carried through your body by particles called lipoproteins.^{1, 2} Your body makes all the blood cholesterol it needs to function, but the foods you eat also contain cholesterol.

Two types of lipoproteins carry cholesterol through your body: high-density lipoproteins (HDL) and low-density lipoproteins (LDL). “A learning tool I use to help explain this is: the “L” of low-density stands for lousy and the “H” of high-density stands for healthy,” says Dr. Bereliani. “Low-density lipoproteins contribute to plaque buildup in the heart, while high levels of HDL might prevent heart disease.”

Myth: High cholesterol shows visible symptoms

Fact: High cholesterol may not show visible symptoms. For some, high cholesterol runs in the family, which is known as called familial hypercholesteremia. It causes high cholesterol that can’t be treated with lifestyle changes alone.¹ “Even if you’re only in your 20s and are healthy, it doesn’t mean you can ignore high cholesterol. If you want to prevent heart attacks in the future, you’ve got to start early,” says Dr. Bereliani.

That’s why it’s key to know your family history — such as whether a relative had a heart attack or stroke — and share it with your health care provider. If family members have had heart conditions or high cholesterol, there is a high chance you do too. You can work with your provider to help you manage high cholesterol, alongside a healthy diet and exercise. In some cases, medication may be necessary, despite your lifestyle habits.

Myth: If I eat low cholesterol foods, I can lower my cholesterol

Fact: In the past, low-cholesterol foods were deemed “good” for heart health, while high-cholesterol foods were said to be bad. But according to recent research, there is little evidence that dietary cholesterol increases the risk of cardiovascular disease.^{3, 4}

Take eggs as an example. Their yolks are rich in cholesterol, but eaten in moderation, they may not necessarily raise cholesterol levels. One study found that eating eggs did not increase cardiovascular risk factors, even for people with type 2 diabetes.³  

If you want to use diet as a way to protect heart health, limit saturated fats and trans fats — both are mostly artificial and come from processed foods.⁵  These types of fats can increase the risk of cardiovascular disease.⁴

While diet and exercise are key ways to help lower cholesterol, high cholesterol can run in the family. “Genetics plays a huge part in cholesterol,” says Dr. Bereliani. “I see some patients who are thin, exercise every day, and yet have high cholesterol. Then there are some who are overweight and sedentary and have normal numbers.”

If you do have risk factors for heart disease — including elevated cholesterol or a family history — you may want to work with a registered dietitian. This person can help you come up with a meal plan that may help lower your cholesterol or keep it in check. The Mediterranean diet, in particular, contains many foods that may help reduce cholesterol, including fish, nuts and avocados.

Myth: Slightly elevated cholesterol levels are okay

Fact: In general, an overall cholesterol level of more than 200 mg/dL is considered high; 150 mg/dL is optimal.⁶ But Dr. Bereliani says that these numbers only tell part of your risk story. “There are different cutoffs I consider based on age and risk factors. There are also additional biomarkers that can be measured through bloodwork. There’s more to check than just good and bad cholesterol.” Slightly elevated numbers may mean additional screening is needed to decide a treatment plan. 

Myth: If I take prescription cholesterol medications, I can eat what I want

Fact: Cholesterol-lowering medication works most effectively with lifestyle modification. If your cholesterol is high, your provider might put you on a statin. This lowers your liver’s production of LDL cholesterol while increasing the liver’s ability to remove LDL cholesterol from your bloodstream.⁷

There are other types of medications that may also be prescribed to lower LDL. But those medications can come with some risk factors. Studies have found statins may be associated with increased insulin resistance, raising the potential risk of type 2 diabetes.⁸ So, it’s also important to work with your doctor on overall lifestyle changes.

Bottom line: cholesterol is complicated. Talk with your doctor about risk factors and your current lifestyle. Make sure to share if you smoke tobacco or marijuana, which are also risk factors for heart disease. And know that even if you’re doing everything “right,” you may still need to manage high cholesterol with medications as part of your overall heart health plan.